Making stroke prevention accessible to everyone

We all know someone whose life changed because of a stroke. Perhaps a relative or close friend who used to be completely independent, and all of a sudden, their life and that of their loved ones changed.

This never felt that close for me until a family member had to become a full-time carer after her partner suffered a stroke. The impact went beyond the considerable costs of adapting their home to meet their needs; it meant that family dynamics changed as my family member had to give up her job and independence.

I was trained as a medical doctor, but I realised that if we want to prevent people from suffering a stroke, we should focus on actions that happen in the community. This motivated me to pursue a career as a public health researcher.  

My research focuses on how we can address health inequalities in stroke that are the result of structural barriers, such as stroke survivors not being able to access a service due to mobility limitations or because the services are not available, and this research spans across sectors and institutions, as real change requires researchers to collaborate with professionals beyond academia.

Preventing a second stroke: challenging but achievable 

Life after a stroke is way more complicated, not only because of the mobility or speech limitations due to the brain damage caused by the lack of blood flow (known as an ischaemic stroke), but also because stroke survivors have up to 15 times more chance of having a second stroke compared to someone who has never had one. In these cases, it is not only about making the right lifestyle decisions, such as exercising or eating healthy. It’s more about ensuring that stroke survivors receive the right medications to reduce their chances of suffering a second stroke. 

We know that prescribing cholesterol-lowering medications (known statins) can reduce cholesterol accumulating in the blood vessels that carry blood to the brain. We also know that blood-thinners (known as anticoagulants) can help reduce the risk of suffering by preventing blood clots from forming in the blood vessels, reducing the risk for a second stroke by up to 66%. But the reality is that not everyone receives these medications. Research has found that between 20 to 40% of stroke survivors are not receiving these medications despite being eligible to receive them, putting them at a higher risk of having a second stroke. 

So, how can we reduce this gap to increase the number of stroke survivors receiving the right medications to prevent a second stroke? The answer might be in the information stroke survivors have already provided when having their follow-up appointments. This is the focus of my current research. 

Using data from GPs, hospitals and other sectors, such as social care, has many benefits: it is already available and does not require additional data collection, it reflects what is actually happening when stroke survivors interact with health services, and it allows us to identify variation in prescribing practices. More importantly, it is deidentified (meaning we don’t know who the patient is), making it safe for research purposes. 

I am currently finalising a pilot study exploring prescription variation practices using data from Connected Bradford, which contains information on over 900,000 individuals from Bradford. This research will allow me to identify who has suffered a stroke in Bradford and then see whether they are receiving cholesterol-lowering and blood-thinning medication when eligible. It will also allow me to see whether there are differences in prescribing practices by sociodemographic characteristics (e.g., age, sex, or ethnicity). 

Initial findings show unequal preventive care 

I have looked at prescription practices from 2020 to 2025, and the initial findings show that around 30% of stroke survivors are missing out on statins, with women and younger people being less likely to receive such medication. Blood-thinners are also more prescribed among men, but this is not surprising, as they also have a higher need for this medication. 

Next steps

The information from the pilot study shows initial insights into the scale of the challenge and how prescription practices vary by age and sex. I am now working with a group of stroke survivors from across the country to develop a new research project that will explore variation in prescribing practices using national data and to conduct interviews with stroke survivors, their carers, and healthcare professionals, such as GPs, nurses, and pharmacists, to understand why this variation happens. This is what we call in research Patient and Public Involvement, or PPI for short.  

The group was created through our Experts by Experience team at the University of Bradford, which helps researchers connect with the community. We meet online to ensure everyone has access to our meetings because people live in different places around the UK, and during our meetings we discuss the focus of the new project and how we will work together as the project progresses.

We have also created a Terms of Reference to ensure every group member has a clear understanding of their role and how their contributions add value to the project. They also have a voice on the training they would like to receive to engage in more advanced parts of the research, such as how to interpret the results of the project. 

The initial meetings with stroke survivors and stroke carers show that their experience interacting with the health system could be improved by making it easier to understand the importance of receiving these medications. Challenges such as healthcare professionals assuming what stroke survivors need seem to be common, as said by a stroke survivor during one of our meetings. Other challenges include language and cultural barriers.  

The project has involved key players in stroke care, such as national stroke leaders, members of the West Yorkshire Integrated Care Board, local and national charities (Different Strokes and the Stroke Association), and local community groups from underrepresented groups (e.g., the Polish community). These key players will be informed of the project results and be aware of any differences in stroke prevention so efforts can be focused among those who are not benefiting from receiving life-changing medication. 

As the research findings continue to unfold, it will become clearer what the best ways are to ensure that everyone, regardless of their age, sex, or ethnicity, receives the right preventive care to reduce the chances of suffering a second stroke, resulting in healthier and longer lives for stroke survivors and their carers.

Image 1: Dr Alejandro Gonzalez Aquines delivering a presentation at the Global Stroke Alliance Conference in Uruguay.

Image 2: Illustration showing build up of cholesterol in blood vessels - high levels of cholesterol in your blood can create a plaque that stops the blood flowing to your brain, causing an ischeamic stroke.  Designed by brgfx / Freepik